In a randomized, double-blind, placebo-controlled setting researchers investigated whether supplementation of estrogen given to men would effect glucose turnover and net muscle glycogen in eleven men over a period of eight days.

The result was intriging.

With estrogen supplementation, the fuel selection of the men was altered - to an increase in lipid use with a reduction in carbohydrate use. Alos, a reduction in glucose rate of appearance, primarily in the liver, and a reduction in glucose rate of disappearance, primarily in muscle uptake, was also noted. One last important finding was in the basal level of total muscle glycogen in study subjects - it was reduced.

Now the good part - what this all means and the reason for my headline.

While the study was done on male subjects, these results suggest that women are designed to have a preference to burn fat for energy - estrogen stimulates and influences the substrate preference for fat. It also helps to explain why women often have a hard time losing weight - especially when they eat a higher carb diet - and why they so easily gain weight when they eat excessive carbohydrate in their diet.

Quite simply, it is how their bodies are designed to work with their estrogen.

As this study demonstrates, estrogen stimulates the selection of fat for energy. But, if the right fuel is not eaten, the body is at a disadvantage for energy selection and use - I've said this many times before, that it is important to provide the body with the right fuel!

For women, that fuel is preferentially fat and a higher carbohydrate diet will inhibit this. A reduction in carbohydrate with adequate protein and fat in the diet will make all the difference. It's called controlled-carb nutrition and it works to bring that balance of fuel for energy, especially for women.

In my previous article I talked about the critical importance of nutrients in our diet - and we get those nutrients from our food. This new article highlights the importance of the food we eat in our health and how the wrong food can mean long-term damage to our genes, sometimes even before we're born.

The article begins with a review of previous research into environmental factors that influence gene expression - in mice and rats - such as foods eaten by pregnant pups and the outcome of offspring and the care of the offspring, neglect or cared for. In new research, the team of researchers showed that a food supplement can have the same effect on well-reared rats at 90 days old - well into adulthood - as neglectful care did in previous research.

The researchers injected L-methionine, a common amino acid and food supplement, into the brains of well-reared rats. The amino acid methylated the glucocorticoid gene, and the animals' behaviour changed. "They were almost exactly like the poorly raised group," says Szyf, who announced his findings at a small meeting on environmental epigenomics earlier this month in Durham, North Carolina.

The researchers believe the reverse may also be true since other research has shown that poorly raised rats - those "stressed" and behaving badly - have been successfully "reversed" to more normal behavior using a chemical called TSA.

Rob Waterland from Baylor College of Medicine in Houston, Texas...says Szyf's ideas are creating a buzz, as they suggest that methylation can influence our DNA well into adulthood. A huge number of diseases are caused by changes to how our DNA is expressed, and this opens up new ways of thinking about how to prevent and treat them, he says.

Indeed it does, and on a more fundamental level than just behavior, but on our health! When we eat the "right" foods - that is those that provide our essential nutrients - we are providing the critical things our body needs to function. When we fill our body with non-nutritive things, like trans-fats, high fructose corn syrup, preservatives or chemicals, we're doing the opposite - we're robbing our body of its ability to thrive.

Yes, it will still function, but that function will be impaired - even if we don't feel it happening at first - and create problems over time. Which brings the question - can such damage be reversed? Can we undo years of poor eating habits?

In my opinion, the vast majority of damage caused by a poor diet can be reversed - it takes time, but the body has an amazing ability to heal itself when given the right tools. Those tools are nutrients, and those we get from our food. Choose the right foods and stay away from those foods that are harmful to health and your body can heal itself in time. And, even if the damage doesn't completely reverse, at least you know you're not doing more damage in the long term when you do modify your diet to be nutrient-dense.

Thursday, November 17, 2005

MedPage Today reported yesterday on new findings from researchers at Yale - Insulin Resistance may be an inherited condition due to reduced mitochondrial activity in muscle cells in the children of those with Type II Diabetes.

That, the researchers said, can lead to insulin resistance even when the progeny are young, lean, and have normal glucose levels.

The finding adds to the weight of evidence suggesting that mitochondrial dysfunction in insulin-resistance pathways may play a major role in the development of type 2 diabetes, suggested endocrinologist Gerald I. Shulman, M.D., Ph.D., a Howard Hughes Medical Institute Investigator at Yale and colleagues at Children's Hospital Boston.The researchers believe these new findings may provide new insights into possible defects that may be responsible or contribute to the development of Type II Diabetes.

"These data support the hypothesis that reductions in mitochondrial content are at least in part responsible for the reduced mitochondrial activity that has previously been described in insulin-resistant offspring."

The changes they detected were independent of changes in other key transcriptional factors and co-regulators of mitochondrial development, they added.

In my mind, this type of research is so important - it underscores the critical need for a nutrient-dense, "real food" diet, especially in pregnant women. From well before we are born until the day we die, our nutrient requirements are fixed - we need essential nutrients to grow, develop, thrive, repair and build cells - without them we are functioning at a less than optimal level and when one is pregnant and not eating a nutrient-dense diet, providing less of the critical "building blocks" for the development of the fetus.

Over time, research such as this, is going to lead to radical changes in our dietary recommendations as our understanding grows even more. Throughout various periods in our life our nutrient requirements change - sometimes we need more fat, sometimes we need more protein - and as we hone in on these changing requirements, our dietary recommendations will develop to be more individualized than we see today.

I also believe that this type of research is going to contribute to the growing area of nutrition based on genetics - perhaps in the future we will see a test of some sort that can provide details to an individual about their genetic predispositions so their diet is tailored to their individual needs from a genetic and cellular level? Ahh, what the future holds for us!

Forbes today reported research findings that show that two carbohydrate-restricted versions of the government's Dietary Approaches to Stop Hypertention (DASH) Diet had beneficial effects on blood pressure, cholesterol levels and long-term cardiovascular risk.

The new diet shifts about 10 percent of calories from carbohydrates to either protein-rich foods or to monounsaturated fats such as olive or canola oil.

"This is a modified version of the old diet," [Dr. Frank] Sacks explained. "The DASH diet was a real breakthrough for lowering blood pressure and we changed it. We reduced the carbohydrate content and replaced it with unsaturated fat or protein, and it lowered blood pressure more and improved lipids, and overall cardiovascular risk goes down."For this study, 164 adults aged 30 and older with elevated blood pressure were assigned to one of three diets: one in which carbohydrates represented 55 percent of calories (close to the original DASH diet); one that shifted 10 percent of carbohydrate calories to protein (about two-thirds from plant sources and the rest from chicken and egg whites); and one that shifted 10 percent of calories to unsaturated fat, mostly olive or canola oils.

What the researchers found was that all participants had some improvements - but those following the diet that reduced carbohydrate saw significantly better improvement. What's more - those on the controlled-carb regiments reduced their cardiovascular risk more than those following the traditional DASH Diet.

With all the continuing evidence that reducing carbohydrate in the diet leads to improvements in health, it makes me wonder why there remains such resistance in the scientific and medical communities to accept the obvious?

As a nation we jumped head-long into the theory of low-fat diets and still continue to perpetrate the myth that low-fat is healthier for everyone.

I've said it before, and I'll say it again - for some individualas, a low-fat diet may indeed be better. But, the evidence is clear that a low-fat approach may also be damaging to the health of other individuals. For those individuals not well-suited metabolically to a low-fat approach, a controlled-carb approach is often a healthier option - an option that must be added to the "toolbox" of options physicians recommend to their patients if/when a low-fat approach is clearly not working or even worsening an individuals health.

In a review of the medical literature about low-carb diets, researchers found something that's been there, in the published data, all along - the list of things carbohydrate restriction improves happens to be the same list of features a patient presents with in the diagnosis of Metabolic Syndrome, a cluster of metabolic markers that increase the risk of diabetes, stroke and heart disease: obesity, high triglycerides, low HDL ("good" cholesterol), high blood sugar, high blood pressure and insulin resistance.

"It's been staring us in the face for years," said Dr. Richard Feinman, PhD, of SUNY Downstate. "Now we've connected the dots."

Now that may not seem like much, but when you consider that in recent months there has been dissent and question about the definition, diagnosis and treatment of Metabolic Syndrome, from some of the leading medical organizations, this is a big deal.

As Jeff Volek, PhD, RD, lead researcher from the University of Connecticut, Storrs said, "Make a list of the features of metabolic syndrome, then, make a list of the things that carbohydrate restriction is good at fixing. They're the same list. Somehow, we never really noticed that. We know the cause of metabolic syndrome is often linked to disruption of insulin. Thus, the key to treating metabolic syndrome is to control insulin, and carbohydrates are the major stimulus for insulin."

The findings of this study should help in establishing a firm diagnosis criteria with observation of the impact carbohydrate restriction has on the markers of Metabolic Syndrome in an individual already diagnoised or suspected of having the disorder. This is a ground-breaking, evidence-based approach that could radically change how the estimated 25% of Americans with Metabolic Syndrome have their symptoms managed and treated!

Often those with the features of Metabolic Syndrome are told to follow a low-fat diet in the course of managing the different markers of the disorder. But, as this study points out, data from published studies shows that low-fat diets often worsen the features of Metabolic Syndrome. The key in these new findings is that fat intake is less of an issue than reducing carbohydrate intake and that how a person responds to carbohydrate restriction may actually be a critical key to diagnose Metabolic Syndrome.

Basically, if a dietary intervention is tried and it restricts carbohydrate wihtout restricting fat and that leads to improvements of the features of Metabolic Syndrome, than that may be the right dietary approach for that person. Too often these days when one is trying to reduce their carbohydrate intake, they also try to limit their fat intake, which makes following a reduced carbohydrate diet difficult.

These findings show that fat intake is less important when a person has Metabolic Syndrome - that the carbohydrate is the key, not the fat in their diet. As Dr. Feinman pointed out, "The most obvious factor in the obesity epidemic is the drastic increase in carbohydrate consumption in recent years and the decrease in fat consumption, so the story is consistent. I think people have learned the value of reducing carbohydrates during the media popularization of low-carb diets, but they are still making it hard for themselves by also trying to reduce fat, when fat seems to be much less important a factor than carbohydrates.”

This article highlights how even those of us who have been deeply involved with controlled carbohydrate nutrition have missed the forest for the trees about just how appropriate a low-carb diet may be for some - when I first read through the paper, my first reaction was "oh yeah - well, duh!" - because it is so obvious, yet until now was not out there, in full view, as it is today.

Dr. Feinman and Dr. Volek, in addition to being co-authors of this paper, are also organizers of the upcoming conference, Nutritional & Metabolic Aspects of Carbohydrate Restriction 2006, in Brooklyn, New York - January 20-22, 2006. For anyone who is interested in nutrition, metabolism, diet and health, this is a must attend conference - there will be three dozen speakers, presenting data from studies across the spectrum of controlled-carb nutrition, many coming from around the world to speak.

Of particular interest to those with Metabolic Syndrome, or phyisicans and other healthcare professionals working with those who have Metabolic Syndrome, will be presentations from Dr. Gerald Shulman from Yale University, Dr. Marc Hellerstein from University of California, Berkeley, Dr. Marcus Stoffel from Rockefeller University, and Dr. Jeff Volek from UConn, Storrs.

Wednesday, November 09, 2005

Yesterday the Daily Mail included an article, Eight factors for childhood obesity, that detailed the findings from a recent study published in the British Journal of Medicine. The study "involved 8,234 youngsters aged seven, plus a further sample of 909 children who were taking part in a large UK study. The children's height and weight were measured and their body mass index - a measure of weight in relation to height - was calculated. The researchers then considered a range of factors which might increase the risk of obesity."

The findings included the following factors that correlated with an increased risk of obesity by age seven:

Birth weight

Obesity in one or both parents

More than eight hours spent watching TV a week at the age of three

A short amount of sleep - less than 10.5 hours a night at the age of three

Size in early life - measured at eight and 18 months

Rapid weight gain in the first year of life

Rapid catch-up growth between birth and two years of age

Early development of body fatness in pre-school years - before the age at which body fat should be increasing (at the age of 5-6)

What's missing?

Have you seen how kids eat today?

Why is diet - what is probably the biggest influence in risk of obesity - not on the list?

It most certainly is a factor - a big one at that. We know this.

Yet, it is not included here.

With the exception, perhaps, of time spent watching television, every factor listed is closely tied to diet - and the case can even be made that links more television time to diet with that additional time spent watching television providing more time to snack in front of the TV.

I don't know how overall diet - foods eaten, quality of those foods, nutrient-density of the diet - failed to make the list. So, here I'm saying it - a nutritionally bankrupt diet in childhood is a significant risk factor for obesity.

Children eat what we feed them - they are not "decision makers" about their diet. If they're offered french fries and soda - guess what? - they're going to consume them willingly. If they're offered instead broccoli florets with dip and water, they might not be all that happy initially with the change, but if they're hungry, they'll consume them willingly too.

When I'm out with my son, who is just 14-months old, I can't tell you how often his eating habits draw the attention of nearby parents who also have small children. Just last week we were shopping at the nearby mall and stopped in the food court for a bite to eat.

Now you may be thinking - the food court? - what could she have possibly found that was not junk food at the food court?

Two quick stops was all it took. First the barbque place for a side of vegetables - the steamed broccoli, red peppers, onions and green beans looked good. Second stop, the salad place for a grilled chicken caesar salad sans the croutons and a bottle of spring water.

At our table, as my son feasted on grilled chicken breast, broccoli, red peppers and green beans along with enjoying his sippy cup of water, and I was enjoying my salad and the remaining chicken, another mom sitting at the next table with her toddler commented that "wow, my son will only eat french fries" as she handed him another one.

For me, moments like this are opportunities - not for judgement, but for education.

So I said that the easiest way to get a child to eat vegetables and things like chicken is to only offer those foods. That her son might protest at first, which is understandable, but she might want to try it and see since I thought she might be surprised how quickly her son will adapt to the change - children of that age simply won't starve themselves, at some point, when they're hungry they will eat the food you give them, even when it's not french fries.

I often write here in my blog about ways parents can make changes in their childrens' diet because it really is so important. Our children are the future and we're letting them down every time we capitulate to what has become "normal" in society - fast food dinners, quick stops at the mini-mart for sodas, packaged processed foods making up the majority of our diet.

This radical change in our eating habits is less than one generation old - most under 30-year-olds will be hard pressed to remember eating out as frequently, eating as much fast food, eating processed & packaged foods as staples, snacking as frequently, drinking as much soda and sweetened beverages, consuming as much junk food, and eating in cars as much as we do today.

Yet, many accept - dare I say, embrace - the changes as normal and even needed in our fast-paced society. As adults we've changed how we eat - for the worse - and we're passing these bad habits to children younger and younger each year.

Too many do not cringe when they see a toddler with a baby bottle filled with soda, instead it's seen as cute.

Too many are not alarmed when a baby is given french fries at the local fast food restaurant, instead it's viewed as giving the baby a "vegetable" and not a food devoid of nutritional value that may be harmful given the fact it contains damaged fats and/or trans-fats.

Too many are quick to give small children bites of donuts, cookies and candy because that's what they're snacking on and the child wants some too.

Today we even buy stollers, car seats and other children's items with built in cup holders and feeding trays! What message is this sending babies and small children?

For those who read this who are parents, or may soon be parents, please think about your child's future and how the decisions you make about what and how you feed your child will have a lasting impact on their health and well-being in the long-term! You are the "decision maker" about what your child eats - use that power of influence and position of authority early and often while they're young to ensure they eat a nutrient-dense diet that is rich with vegetables and other good, nutritious food instead of worthless junk food.

Monday, November 07, 2005

WJLA-ABC News reported today on a study that found two million adolescents have pre-diabetes. The study appears in November's Pediatrics, being published Monday. It is based on data involving 915 youngsters who participated in a 1999-2000 national health survey.

To assess those participating, researchers used the American Diabetes Association critera to determine how many were diabetic and how many were pre-diabetic. Pre-diabetes is defined as a fasting blood glucose of 100ml/dL or greater, yet below 125ml/dL; diabetic is 125ml/dL or greater.

The average level was 89.7, within the normal range, but 7 percent of the children in the study were in the pre-diabetic range, translating to about 2 million U.S. youngsters. Roughly 16 percent of the youngsters studied were obese, about the same as recent national estimates.

Also noteable, those children affected also had other risk markers for other health issues, like future heart disease - both LDL cholesterol and triglycerides were markedly higher in those teens with elevated blood glucose levels.

Why is this important?

For one thing, it is a big red flag that something is wrong with the diet of our children - the abnormally high blood sugar levels are wrecking havoc on their internal organs, slowly, insidiously - and it isn't because something is wrong with their metabolism...something is wrong with their diet.

Until recently, Type II Diabetes was a disease of "old age" - something that happened over time to a small population of older people.

Over time, as the body becomes "insulin resistant," it becomes less efficient at using insulin and blood sugar levels may rise to levels that are damaging when they're higher than normal day-in-day-out. For decades we have taken the perspective that pre-diabetes and diabetes (Type II) is the body's inability to properly use the blood sugar lowering hormone, insulin. And while this view is "accurate," it removes from the discussion table the cause of the condition and makes it one of metabolic disfunction rather than metabolic overload.

To be clear, it is a disfunction, but not one that is just random, that strikes without any predictability; nor is it caused by something "going wrong" in the body - it is a condition created by the wrong environment for optimal function of the body; an environment that over time causes the disfunction in the metabolism.

This metabolic overload does take a predictable path - weight gain, decreased physical activity, rising LDL, skyrocketing triglycerides, increasing fasting blood glucose levels, insulin resistance, more weight gain, damage to internal organs, high blood pressure, etc. - until the body reaches a state of Type II Diabetes with underlying medical issues that must also be addressed.

The obesity and Type II Diabetes are outward symptoms of something much more insidious.

What is fueling this disfunction is not a metabolism gone awry, but years of eating a poor diet and consuming what can only be described as excessive carbohydrate in a state of malnutrition. This excess of carbohydrate and a chronic failure to meet nutrient requirements is exhausting the metabolism - exhausting the body's ability to produce and effectively use insulin.

It is time we change our perspective to one that addresses the underlying problem - poor diet - and stop pretending it isn't the increase in carbohydrate, to excessive levels, in our diet that is causing the numbers of children, adolescents and adults that become obese to continue climb and the numbers being diagnoised with pre-diabetes and diabetes to skyrocket along with other symptoms like dyslipidemia and high blood pressure.

What was once a long-term "wear-and-tear" disease seen in older people is now, with increasing and alarming frequency, afflicting our children. When are we going to stand up and say "enough is enough" - how many millions of children must be diagnoised before we finally step up and truthfully state the problem and give parents the solution to try to prevent this in their children?

This isn't rocket science.

Excessive carbohydrate translates, in the metabolism, to high levels of blood glucose that the body MUST manage with insulin. Insulin is the ONLY means of lowering blood glucose and the path of least resistance is to store excess blood glucose as body fat. The body only has a finite capacity to use glucose metabolized from carbohydrate for immediate energy and a finite capacity to store excess blood glucose as glycogen. Anything above and beyond these finite limits is stored as body fat to use later for energy when needed - and there is no "finite" storage capacity for body fat...it just keeps going and going.

The problem with this is that later never comes - one gets hungry again, eats again, eats an excess of carbohydrate again, and continues the vicious cycle in the metabolism, growing fatter and fatter while their ability to effectively use insulin diminishes, which steps up the vicious cycle and starts to cause lasting damage. What used to take multiple decades to develop is now taking just a few years - if that isn't a wake-up call, I don't know what is.

The daily diet of our children and our teens is littered with junk food - and not just occassionally, but every day, day after day, for the average kid.

Our children don't have some new defect in their genes or their metabolism - they are being fed a defective, nutritionally bankrupt diet.

Children and teens REQUIRE a nutrient-dense diet every day and each time they are fed or eat something that is nutritionally bankrupt, thier body is being robbed of long-term health; being robbed of an ability to function properly to optimize their health.

Think about that next time you see a toddler with a baby bottle filled with cola or eating french fries at the local fast food restaurant; think about that next time you see a teen guzzle down a huge slurpee or buy a bag of chips and a bottle of soda for lunch; think about that next time you shop for dinner for your family and have to decide between the fried chicken bucket with mashed potatoes, corn, biscuits, a pie and a 'bucket-o-soda' from the drive through or picking up some chicken breasts, green salad, green beans and carrots with some lemon essence mineral water and fresh berries for dinner instead.

Medical News Today carried an article about a study published last week in The Lancet that found waist-hip ratio is a stronger predictor of heart disease risk than BMI.

If obesity is redefined using waist-to-hip ratio instead of BMI the proportion of people at risk of heart attack increases by threefold, calculate the authors. Previous research has shown that obesity increases the risk of heart disease.

In the latest study, Salim Yusuf (McMaster University, Ontario, Canada) and colleagues aimed to assess whether other markers for obesity, especially waist-to-hip ratio, would be a stronger predictor of heart attack than the conventional measure of BMI in different ethnic populations.Their findings were impressive. The researchers looked at BMI, waist-to-hip ratio, waist measure, and hip measure in over 27,000 people from 52 countries. Half of those assessed had previously had a heart attack, the other half had not. Both groups were age and sex-matched.

The team found that BMI was only slightly higher in heart attack patients than in controls, with no difference in the middle east and South Asia. By contrast, heart attack patients had a strikingly higher waist-to-hip ratio than controls, irrespective of other cardiovascular risk factors.

We know that heart attacks do not strike only those who are overweight or obese, so a better measurement of risk may in fact be waist-hip ratio since even a thin person would still have a measurable ratio of their waistline and their hips to assess their risk.

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Friday, November 04, 2005

The more I continue to follow-up on the progress of the Fat Man Walking, the more I wish someone would do something help him understand how to modify his diet as he continues his walk! With his continued poor diet, he may be doing himself more harm than good in the long-term.

He started his journey to walk across the United States back in April, in an effort to lose weight.

I am not happy because I am fat and being fat makes every day unhappy. I did not make this website to complain about it however, instead I am doing something about it and this site was made to chronicle my story. I am going to walk across the United states from San Diego to NYC to lose weight and regain my life!

Over the last seven months, Steve Vaught has walked 1338-miles from San Diego, CA to Edmond, OK and has another 1478-miles to go before reaching New York, NY.

How much weight has he lost?

73-pounds, according to his journal entry dated October 28, 2005. His starting weight was about 400-pounds and he is now 337-pounds.

While I am thrilled to see his perseverance, I am totally unimpressed with how he continues to eat - in fact, I worry, as I said before, that he may be doing more harm than good. He readily admits he now understands he is "addicted" to sugar, yet continues to consume sugary foods and beverages, while continuing on a physically demanding walk across the country.

For all of the efforts over the past seven months I still routinely blow it by giving in to my weaknesses. If I can force myself to do this walk then why can’t I force myself to be more responsible with my food choices?

He is unimpressed with how much weight he's lost, he thought by this time he would have lost more.

He should have and could have - if he'd modified his diet appropriately for the physical demands of this walk.

I'm not including the following comparison to dog him, but to show that his weight loss is not working the way it should...

Has anyone sat down with him and really told him how critical it is to provide his body with the "raw materials" it requires to "build and repair" his cells & tissue - especially his muscle - while he is doing this? You know, the protein and fat? He doesn't need the added sugars or the junk foods on this walk - he needs real food, rich with amino acids and fatty acids; foods that are nutrient-dense and optimize health - otherwise he's robbing his body in the long-term, especially with the demands of this walk!

Seventy-three pounds may sound impressive - but when one looks at the time and effort to realize the result, it is clear something is wrong with this picture. He's almost at the half-way mark of his journey - there is still time for him to do this in a way that is going to allow him to lose weight while not causing long-term damage to his body - isn't his goal to get himself healthy for the long-term?

A review of the book can be found at the Los Angeles Times CalendarLive.com site."[W]e are not getting diabetes, cancer, and heart disease because of how much we weigh; we are getting these problems partly because of how and what we eat" — and too little exercise.

I just ordered the book myself and once I've had a chance to read it, I'll post a complete review. In the meantime, I've included it here since it looks like a great read. If any of my readers have comments about the book, email me and I'll try to include viewer comments in my review in the next week or so!

This entry is just an exercise in reviewing the sheer madness found in our dietary recommendations about consuming fat. I haven't seen anyone else challenge this, so I thought I'd put it out there for my readers to chew on...

A funy thing happens when you review the 2005 Dietary Guidelines for Americans...the more calories you eat, the more saturated fat you can consume as part of that, ahem, "healthy" diet. But, don't dare to even think of including the same level of total or saturated fat when you diet to lose weight and decrease your calories! No, no, no - if you decrease calories, suddenly that level of total and saturated fat you're already eating, that is well within the 30% limit at a higher calorie load, is now deadly!

That's because the dietary guidelines depend on ratios (percentage) of calories from the various macronutients (carbs, proteins, fats) rather than the actual nutrient-density of any given food.

So while at a 2800-calorie per day intake it is perfectly acceptable to eat 93g of total fat with 31g of saturated fat, it is completely unacceptable if you reduce calories to 1600-per-day, where you are now expected to limit your total fat to just 53g and saturated fat to just 18g or less. This ridiculous recommendation is clear in Chapter 6: Fat, of the 2005 Dietary Guidelines for Americans.

So, where is the evidence to support the notion that eating 31g of saturated fat in a 2800-calorie diet is okay, but eating 31g of saturated fat at 1600-calories is unhealthy?

Oh, that's right, there is NONE. Yet we accept the fallacy that we have to reduce total and saturated fat intake when we reduce calorie intake to lose weight.

Hey, I'm all for eliminating the man-made trans-fats from your diet, and if you're eating an excessive amount of fats/oils, reduce them. But the sad reality is that many people who need to lose weight are eating too much junk food - foods that are highly processed and loaded with added sugars. If you eliminate those junk foods along with sugar-added beverages and maintain a healthy level of fats and proteins, guess what? It's called controlled-carb and such an approach makes a lot more sense than reducing protein, which happens when you reduce fat, which means less essential fatty acids and less essential amino acids.

Thursday, November 03, 2005

So, what is an overweight or obese person to do before they start a diet?

On the one hand, the public is told repeatedly to see their doctor before starting a diet to lose weight; on the other, they're cautioned that their doctor's advice and treatment might be dangerous.

Last month I tackled the subject of "Medical Weight Management" programs run by doctors and clinics that claim to have proven programs that you can lose weight with only if you are their patient. Many of these programs are counting on the fact that most people trust doctors; thus if a doctor is overseeing the diet, it is somehow better for them and their health.

An article today at WCCO-TV highlights the fact that there is no board certification for doctors wishing to claim expertise in diet and weight loss.

However, special training is not a requirement for the 2,500 doctors now in the field of medical weight loss. There is no residency program or recognized board certification.

The article continues that "experience and training are vital because diet doctors commonly dole out appetite suppressants and other medications that can have serious side effects."

The main criticisms in the article include:

Doctors in non-practice fields hanging out the shingle to open a diet centered practice

Doctors doling out appetite suppressants and other medications like candy

Focus on short-term weight loss rather than diet and lifestyle change for the long-term

Doctors pushing products, like supplements and nutrition bars, on patients

While these are valid criticisms, the very same I myself wrote about in my previous article, they do not, in my opinion, represent the vast majority of doctors out there who are working with their patients to help them lose weight - general practitioners and family doctors. And, let's not forget those doctors who are "specialized," who work daily with patients who have specific medical issues and are overweight or obese - cardiologists, bariatric surgeons, endocrinologists, OB/GYNs, pediatricians...heck, every last specialty out there has doctors with patients who need to lose weight!

We do need change though.

The medical establishment does not need to specialize - again - "weight loss" or "bariatrics" into a board certified specialty - there already does exist an organization that DOES certify physicians specialized in medical weight management - The American Board of Bariatric Medicine (ASBP), that has a seat in the American Medical Association's (AMA) House of Delegates.

Granted, they are not recognized by the American Board of Medical Specialties - but do we really need this, or do we need all doctors to be educated about dietary approaches for weight loss?

There already exist enough specialties, in addition to those already board certified by the ASBP, where weight loss is a "good fit" - endocrinology is one obvious example, since many who are overweight also have underlying metabolic/hormonal issues causing or contributing to their weight and endocrinologists are specifically trained to manage these metabolic/hormonal complications while working with other specialists a patient may be seeing too, like a cardiologist who may also be treating the same patient for a heart condition.

In my opinion, we don't need another layer of "specialist" in the treatment picture - we already have enough specialties, already have an organizations "board certifying" for bariatric medicine, and even have plenty general practitioners who are highly qualified to help patients lose weight.

What we really need is to have them all educated about all the available evidence-based approaches in their "toolboxes" of options to consider for an individual patient.

There is no "one-size-fits-all" approach that will work for everyone. We know this. Yet, we continue to hammer away at educating physicians and the general public that it is as simple as "eating less and exercising more," reduce fat intake, increase whole grains, eat a varied diet and everything in moderation will work for everyone.

Doctors from all specialities need to know about and understand how the various, scientifically-supported, dietary approaches work, whom they are appropriate for, how to monitor effectiveness and when to try something different. These various approaches include calorie restriction - portion control, low-fat, low-carb, controlled-carb, glycemic index/load, and yes, even vegetarian approaches.

Until we address the fact that no one diet will work for everyone we will not reverse the obesity epidemic anytime soon. It is high time we set aside the "politically correct" dietary dogma and got down to business to address the real issue here - the use of evidence as the foundation to help a patient lose weight, instead of our current "consensus opinion," industry-influenced based recommendations that fail for so many.

What we need now isn't more "specialists," but someone to bring it all together to create a useful clinical practice guideline package for physicians to use!

In the meantime, consumers - the general public - should find a doctor they trust, one who treats them as an individual and considers their medical history and dietary needs and isn't just hawking their own "program" that requires a patient to buy their products to realize success in their weight loss effort.

Wednesday, November 02, 2005

The media may think low-carb diets are dead, but researchers at institutions around the world - from the University of Connecticut, Storrs to the Albert Einstein College of Medicine...from Institut National Agronomique, Paris-Grignon to the School of Medicine of Ribeirão Preto, University of São Paulo, Brazil - continue to study the effects of carbohydrate restriction as an option for weight loss and the management of a number of diseases and disorders.

Their interests are diverse, seeking answers to questions such as:

What does carbohydrate restriction do in metabolism?

How is carbohydrate restriction effective in disease management?

Why is a low-carb diet effective for some and not others?

What is different in a low-carb diet nutritionally than other dietary approaches?

What mechanisms are at work to spare lean body mass during carbohydrate restriction?

What's going on with cholesterol during carbohydrate restriction and why?

What is the role of visceral abdominal fat in Metabolic syndrome?

How does body composition and hormonal responses change in a carbohydrate-restricted diet?

This is the second conference hosted by SUNY Downstate and the Nutrition & Metabolism Society that will bring together researchers from around the world to present findings and explore the role of carbohydrate restriction in weight management and nutritional health.

The conference will take place January 20-22, 2006 in Brooklyn, New York. Presentations from distinguished researchers, scientists and medical professionals include:

Marc Hellerstein, MD, PhD, Associate Professor of Nutritional Sciences and an Associate Nutritionist at the University of California in Berkeley

Fredric B. Kraemer, PhD, Professor of Medicine and Chief of the Division of Endocrinology, Gerontology and Metabolism at Stanford University

Gary J. Schwartz, PhD, Professor of Medicine and Neuroscience at the Albert Einstein College of Medicine

Gerald I. Shulman, MD, PhD, Professor of Medicine and Cellular and Molecular Physiology at Yale University

Mary C. Gannon, PhD, Professor of Food Science and Nutrition, and Associate Professor of Medicine at the University of Minnesota and Director of the Metabolic Research Laboratory at the Minneapolis VA Medical Center

Throughout the three-day conference, dozens of speakersare scheduled along with time for roundtable and panel discussions and questions and answers.

The conference is of special interest to researchers, scientists and medical professionals - and also well worth attending for those who are from industry and want to understand the ins-and-outs of carbohydrate restriction as a dietary approach. And, let's not forget consumers, who want and need clear, concise information about the evidence, presented directly from those who are researching low-carb and controlled-carb diets!

Reuters Health reported today that a high number of cancer is due to obesity. The data comes from a review of published studies, updates to the International Agency for Research on Cancer (IARC) report from 2002, and data from the Nurses' Health Study II by researchers at the Harvard School of Public Health.

If no one was overweight or obese, the data shows we would avoid:

14% of colon cancers (14,000 cases)

11% of breast cancer (over 18,000 cases)

49% of endometrial cancer (almost 20,000 cases)

31% of kidney cancer (over 11,000 cases)

39% of esophageal cancer (5,500 cases)

14% percent of pancreas cancers (4,500 cases)

20% of non-Hodgkin lymphoma cases (over 11,000 cases)

17% of multiple myeloma cases

Dr. Graham Coldtiz, from the Harvard School of Public Health stated that "We can clearly conclude that adult overweight and obesity cause cancer, and increasing rates of obesity in the US are continuing to drive up the burden of these cancers."

That's a very strong statement - that obesity causes cancer.

Is it true though?

In my mind it is a very questionable conclusion, stated unequivocally, since it fails to address what causes obesity. It's like trying to determine which came first, the chicken or the egg.

While it is very possible, and probably even true, that a high level of excess body fat - obesity - does actually cause some cancers...generalizing that obesity is the cause of so many cancers misses the real underlying cause in too many others who are diagnoised with cancer - a poor diet. A diet so bankrupt in nutrients that even with more calories than required (which caused the obesity) still leaves the body vulnerable to disease and degeneration.

To me this is the start of a questionable precedent in our understanding of the disease process which may turn our focus away from the very important issue of what is causing obesity, which is causing the cancers.

In too many cases, obesity is a "result of" something else, and that something else is also what causes cancer - poor diet.

Tuesday, November 01, 2005

This morning I had an opportunity to watch the second episode and was left completely unimpressed. The show offered no new insights or advice and the results of those "eating less" and "exercising more" to lose weight in a "real world" setting - and actually highlighted why so many fail with such recommendations.

The show follows those hoping to lose weight before an upcoming event for 90-days. So the final results are based on a three-month program that encourages eating less calories and exercising more. The participants keep video diaries to provide viewers with insights into their struggles along the way.

The show I caught was Cruise Ladies/SNL. The website promotes the show by asking "Long time friends Shawnta, Lea and Nampombe have a vacation cruise to Mexico coming up, and their mindless snacking and love of decadent desserts has led them to weigh more than they'd like. Can Juan Carlos Cruz help them eat what they love, and lose weight?"

Throughout the show were the expected recommendations - "eat low-fat," "choose low-calorie," and "exercise portion control" along with some innovative attempts to get participants to do just that with "500-calorie meals" that included chocolate candy as part of the meal.

So just how did the three women do?

The results were totally unimpressive for the level of effort and support provided. While these women lived in the "real world" they were also provided with a nutritionist and personal trainer - something few have the luxury of affording, to be at their disposal day after day for three months, in the real world.

How did they do at the end of ninety-days?

Shawnta lost 13-pounds

Lea lost 14-pounds

Nampombe lost 16-pounds

The first month results were losses of 3-pounds on average; month two increased to an average loss of about 8-pounds more lost; and month three saw the ladies lose less with about 6-pounds lost. This was while combining a reduction in calories with an increase in activity! These unimpressive results were celebrated as if they were incredible!

What no one can tell you is how much of that weight loss was water, body fat or lean body mass. The show also failed to address the importance of essential nutrients and instead focused on how to reduce fat intake instead - often with the recommendation to add sugars to boost palatability.

Case in point - the recipe for Roasted Pineapple includes 1/2 cup of brown sugar. Pineapple is sweet without additional sugars and roasting it brings out the sweetness, so the addition of sugar boosted the carbohydrate per serving from 9.6g with 1g of fiber (8.6g net) to 20g with 1g of fiber (19g net). This recipe does nothing to help anyone learn to enjoy the natural sweetness of fruits and actually had more calories because of the added sugar!

Don't get me wrong - these women did lose some weight - we just don't know how healthy that weight loss was or if they've been able to lose anymore or keep off what they did lose.

There are better, healthier, more impressive ways to lose weight...and not just weight, but actual body fat. The research clearly shows that controlling carbohydrate offers much more impressive body fat losses in 90-days and that those eating a carbohydrate restricted diet don't have the same level of stuggle with hunger - they report much higher levels of satiety throughout their calorie restriction. More impressive - the calorie restriction is often not forced, but just happens naturally even when dieters are allowed to eat whatever they want from the foods that are allowed.

With more and more of the "reality television" shows focusing on weight loss, it's important to remember that it isn't just the numbers on the scale - healthy weight loss is FAT LOSS, is nutrient-dense and shouldn't be a struggle each day! Controlled-carb plans offer you all of the above, but you're not going to hear much about them on television - it's just not in their best interest since network revenue relies heavily on processed food company advertising dollars, and controlled-carb diets are mostly whole foods.